Implementing quality improvement strategies in Brazilian hospitals: A model for guidance of the initial stage of implementation

Since the early 1990s, Brazilian hospitals have increasingly adopted quality improvement strategies with a view to attending more demanding customers and to the higher performance standards required by the Ministry of Health. However, most efforts have not been successful, partly because hospitals lack adequate methodologies, namely implementation models. This paper presents a two-stage model to help Brazilian hospitals deploy such strategies more effectively. It focuses on the development and pilot-test of the model for the buy-in stage. Distinctive features of the model were found to be critical for results at this stage: 1) An ad hoc structure to manage the changes involved; 2) A performance measurement system to lever and monitor its implementation, while aligning the actions taken with strategy objectives. Other aspects found to be crucial for success were creative application of model elements to the culture of the hospital and to Brazilian contingencies.